Name Birthdate dd/mm/yy Guardian Address Authorized Pick-up       City Postal Code Home Phone Cell/Work Phone Emergency Contact     Emergency Phone     E-mail     Allergies or special needs Desired Week Course Name zAmazing MiniArt - Fall Termz     Day/time of classes Wednesdays 1PM-2:30PM AND Saturdays 10AM-11:30AM     Course Fee $345.00     Materials Fee Materials & healthy snack included     Total Cost $345.00